In the meantime the event resources are here.
We’ll be updating these resources after the event to ensure it lives on and achieves real change.
Steve Turner on ‘Why I set up the Turn Up The Volume! event’ – ‘Reflections on the ‘dark side’
The Turn Up The Volume Conference aims to promote best practice in patient safety:
Why did I set it up?
I’m not in the conference business so why did I take the risk of setting up, promoting and delivering a national event? I’ll attempt to explain.
There are plenty of reports, reviews and consultations on the need for an open culture and an end to bullying in healthcare organisations. In fact if you start with the Francis Review into Mid Staffordshire, by my calculation we are now on to the eighth. That’s a lot of talking and precious little action.
They all refer to the same thing, best expressed by Sir Robert Francis who agreed that the treatment of whistleblowers in the NHS has been abysmal.
In fact, The Freedom to speak up review report contains damning information on what happens when staff are not valued and listened to, leading to the statement that ‘The effect of the experiences has in some cases been truly shocking’. The report makes disturbing reading and links the culture of ‘fear, blame, defensiveness and scapegoating’ directly to patient safety.
This fires me up because I’ve had an unusual career and seen things from many angles. I’ve been a senior manager, management consultant and specialist clinician. I’ve worked for the NHS and for a US healthcare firm. So you could say I’ve been to the ‘dark side’ and back, depending on your views as to where the ‘dark side’ is.
Many of the jobs I’ve had involved, and continue to involve, working across several NHS trusts and organisations. Here I’ve seen, and continue to see, the best and worst of care and the best and worst of cultures. This variability which exists even today is alarming. Critically within a single organization cultures can vary massively, and patient safety is affected accordingly.
So what do we need to do?
In my view there is no organisation, professional group or body that represents a ‘dark side’ it’s about how we behave individually and together and how we treat each other.
Times are tough and people get pressured but there is no excuse for being uncivil or not listening. When this type of behavior gets copied it works like a toxin in organisations.
If you want to see a better explanation of this I recommend this talk on Developing Cultures of High Quality Care by Michael West:
So now’s the time to act together to break down barriers and tribalism, and cut across hierarchies for safer care. We will all benefit and services will be safer.
Useful resources:
Turn Up The Volume Conference Resource page
Steve’s blog on culture and leadership in healthcare
Steve’ blog on bullying and accountability
Personal views of the author: Steve Turner
Last updated: 18/10/2016
Pushing the boundaries
Pushing the boundaries
At Care Right Now we love pushing the boundaries. If someone, especially someone in ‘authority’, tells us it’s not possible it just makes us more determined.
For info there the latest on our work with people with long term conditions:
https://www.carerightnow.co.uk/condition-management/
…what do attendees on our course say?
‘You should listen to those guys. You will learn something’ April Attendee 2015.
It’s the power of patients and the public which will drive forward safer and more cost effective care, and this doesn’t need complex jargon or rules, or to be stage managed by existing bodies.
Here’s another example of a successful project which pushed the boundaries:
https://www.carerightnow.co.uk/parent-held-medicine-records/
Author: Steve Turner 11/5/15
The right to speak up……..Guest blog from Dr Kim Holt
‘The right to speak up……..
Whistleblowing laws were brought in following tragedies such as the Herald of Free enterprise disaster. The legislation was intended to prevent workers raising concerns from being dismissed. This has failed abysmally as Sir Robert Francis stated in the Speaking up review, at best the law (Public Interest Discrimination Act) has limited effectiveness.
At least that gap is now acknowledged. It’s been accepted. So whilst the law remains ineffectual workers remain unsafe. That’s the least of our problems.
Patients First has grown organically from a handful of campaigners to a large and growing network of health professionals who have fought against a system that has been cruel and vindictive in too many cases. The stories of breakdown and loss have been heart breaking to hear. Personally I have listened to maybe thirty or forty similar heart wrenching stories of severe bullying, ignoring of the concerns and failing health and well being. Sir Robert Francis detailed similar in his report published last week.
Patients First contributed by submitting a summary of 70 cases in a thematic review. The patterns used to try and make the individual the focus rather than the issue are remarkable.
Attending a rally last week an eloquent doctor asked how listening to these stories Sir Robert could bear to leave these individuals unresolved. He has. There needs to be some process of reconciliation for the historic cases, as well as most importantly learning from them.
My own journey of whistleblowing took me through all the layers of internal management to the regulators and eventually the media. Until I received support from my MP and the media investigating the ~Peter Connelley story, I didn’t feel that my concerns were being listened to or taken seriously. Colleagues of mine who tried at the same time to speak up, resigned out of frustration, but also felt used by a system that didn’t really care to hear our views. NHS London who investigated my concerns in 2009, treated them as an employment matter rather than a patient safety issue, completely missing the point. The Health Select committee agreed that employment tribunals are not the place for patient safety matters to be heard. Yet this still goes on.
Now its clear that bullying is a major problem and can be linked to raising concerns. The leadership of the NHS will now have to start addressing that by training and more robust support for staff. Unions need to rethink their response to requests for help when staff report bullying, and much earlier intervention generally, and better psychological support is essential. I proposed an early intervention scheme which has been in principle accepted by NHS employers as a good way forward and currently sits with the Department of Health.
This would allow an external scrutiny early one where clinicians or managers are raising concerns about patient safety. The focus would be the patient safety, not the individual.
Whistleblowing externally to regulators and politicians also needs to have a better system in place, and we need to see an end to the post code lottery that currently exists. Some people receive brilliant support from their MP, others have been ignored.
Campaigners have achieved a lot in having these issues heard and now accepted, now we look to government and politicians to ensure that there is fairness for all and no more turning away from difficult issues.
These are my own personal views.
I founded the Patients First network in 2011, contact them at patientspfirst@aol.com
@PatientsFirstUK
Dr Kim Holt’
Click here for the link to the Patients First web site
This article first appeared in the Shaping Our Lives Newsletter Spring 2015 – Issue 23
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Identifying bullying – why accountability and connections are so important
Although I’m not an academic and haven’t studied bullying in depth, I’ve experienced it and I’ve also been in situations where, I now recognise, I took a bullying approach. This has led me to consider the difference between accountability and bullying:
Accountability
The key thing for me is the difference between holding people to account (e.g. by openly discussing problematic beliefs and behaviours) and bullying. Accountable actions are driven by the intention / motivation of helping all involved and building an interconnected community based on honesty and trust. (‘Tough love’ if you like).
Bullying
Contrast this to the scenario where bullies criticise people without being specific about what’s being questioned, act secretly and withhold information, blacklist people, create over complex rules which can’t be followed and hide behind bureaucracy and hierarchy.
Sepcific bullying behaviours include undermining, whispering campaigns, behind closed doors conversations etc.
In my experience, around the time of my protected disclosure, I was involved in meetings and discussions where those who had set up the meeting had not stated the purpose of the meeting in advance (or on one occasion deliberately misled me). In these meetings they had clearly rehearsed their questions. Questions that were designed to belittle and discredit.
Sounds familiar?
In these cases this seems to be motivated by a desire to hold on to power, deny failings, use ‘playground’ tactics and break connections which aren’t in line with the overall agenda (often not made public).
These behaviours are frequently the result of bullying from higher up the chain, and a culture where leaders are not comfortable with ambiguity.
Bullying in this context is not always recognised as such, and victims are made to feel it may be their fault. This compromises patient safety.
This is a problem which affects all areas of work, not just the UK National Health Service [NHS]. I remain optimistic that, because of the profile this issue now has in the NHS, things are changing. There’s a long way to go yet and many injustices to be rectified.
‘People deal far better with uncertainty and stress when they know what’s going on, even if the information is incomplete and only temporarily correct. Freely circulating information helps create trust, and it turns us into rapid and more effective learners’
Margaret J Wheatley (2007) ‘Finding our Way. Leadership For an Uncertain Time’. Berrett-Kohler Publishers Inc. San Francisco
Click here for the Care Right Now approach to engagement and leadership
Author: Steve Turner Updated April 2019.